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Why Millennial Men Don’t Go to Therapy

The most depressed generation won’t get help despite having more access than ever before

About eight years ago, Eugene was in the midst of transferring colleges when he noticed how his mood sagged, seemingly at random times, triggered by the smallest things. He had spent the previous two years at a California State University “smoking, drinking and playing computer games” before realizing that he was treading water and wasting time. He felt envy toward friends who had a career path, but also contempt for other students who were either coasting or were just plain dumb.

Eventually, Eugene dropped out of school, aiming to transfer to a more prestigious private university. But over the next few months, daily routines like pulling himself out of bed and getting dressed loomed over him with daunting effect. “I just didn’t feel great,” he says. “Everything looked bad, and I couldn’t shake it. Then you wake up one day and think things like, Why don’t I just fucking kill myself? That made me step back, and wonder what was really wrong.”

It took conversations with a therapist for Eugene to realize that changing schools was more of a bandage than a solution to his slump. Sometimes he’d lay awake at night, wondering if a millennial hitting his prime in a post-recession economy could ever achieve real, lasting success — or what that success even looked like. He also mulled over his new diagnosis of chronic depression, which needed to be managed with medication and more talk therapy.

Eugene, a Korean-American, felt especially lucky that his mother was “very liberal” about accepting his struggles. “What’s really harmful in my case is that we as Asian-Americans are taught that it’s not mental illness, it’s just a normative challenge in life. And in Eastern Asian culture, the idea of functional mental illness isn’t really a thing. It’s called ‘get over it,’” he says.

“At the same time,” he muses, “how do I fix this problem? It’s a product of culture.”

It’s a question the entire millennial generation, defined roughly as those born between the early 1980s and early 2000s (currently 18 to 35 years of age), is grappling with. Search the web for information on millennials and mental health and the headlines flow forth: “A Generation on Edge”; “Why Millennials Are Struggling with Mental Health at Work”; “Millennials are Facing a Mental Health Crisis, and It Was Entirely Preventable”; “Millennials and How They’re Helping Destigmatize Mental Illness”; and even “How Memes Taught Millennials to Talk About Mental Health.”

More formal research paints a similar picture, especially for millennials navigating the muddy waters of college. Between 2009 and 2015, enrollment in U.S. colleges grew an average of 6 percent, but saw a roughly 30 percent increase in the number of students visiting counseling centers, according to the Center of Collegiate Mental Health. Last year, a major survey of 63,000 students at 92 schools found that almost 40 percent of respondents felt so depressed that it was “difficult to function”; 61 percent said they felt at least one instance of “overwhelming anxiety” in the prior year, per the American College Health Association.

A patchwork of issues is contributing to the generation’s anxiety, though it’s hard to pinpoint the driving force. Is it a fast-paced modern lifestyle? Shifts in parenting styles? The peaks and valleys of an unpredictable economy? Anxieties about student debt and not being able to afford a home? Being the first generation to grow up with the internet and the toxic culture of social media? A debilitating addiction to avocado toast, rosé or all things pink?

On one hand, there’s nothing new about young adults struggling: The expert consensus suggests that this age group is hit with higher rates of stress and self-questioning in every generation, not just millennials. But the difference here is that there’s also growing evidence that millennials are suffering from higher-than-usual rates of mental health disorders, with some major factors unique to the culture and lifestyle of the 2000s, according to Morley Winograd, author of Millennial Momentum: How a New Generation Is Remaking America and a professor at the University of Southern California.

“The ‘snowflake’ insult is a creation of Fox News and the like, but because of the way millennials were raised, with support and attention from helicopter parents who have worked to build kids’ self-esteem, they haven’t encountered as many difficulties in life, broadly speaking. This doesn’t make them any less resilient. Remember, the GI generation was called ‘mama’s boys’ at the start of World War II,” he explains.

Regarding resiliency, a study released in January surveyed 40,000 American, Canadian and British college students and found that millennials are suffering from “multidimensional perfectionism” in multiple channels of their lives, setting unrealistically high expectations and being hurt when they fall short. Researchers say the findings (published in the journal Psychological Bulletin) correlate with increasing rates of anxiety, depression and eating disorders in millennials, too.

“Millennials tend to be more isolationist,” says Reef Karim, who has seen a swell of young people walk through the doors of his Beverly Hills outpatient clinic The Control Center, where he and the staff help treat mental health and addiction issues. “They’re idealistic at the same time, but as much as they feel like they want to connect more through volunteerism, activism and social media, they tend to have less emotional armor. As great as social media is, in many ways, it’s almost preying on the vulnerabilities of some people in terms of creating perfectionistic behavior. And young people feel overburdened.”

For millennial men in particular, a major challenge is understanding that they’re suffering from disorders in the first place — and finding someone who can help shoulder the burden of their struggles. A major British study found that the odds of male “friendlessness” nearly triple between the early 20s and late middle age, with married men especially reporting that they don’t have a close friend to turn to for support outside of the home.

Meanwhile, professional therapists could fill an empty space for men who need to talk about what’s bothering them, but men are often reluctant to buy into the premise that a stranger can, or should, be trusted to fix their problems, Karim says. “The women we see tend to come in on their own accord, thinking, Hey, there’s something going on with me, so I’m gonna do an intake and see if I need help. Whereas a lot of the men are coming in because of their spouse, girlfriend or mom,” Karim says. “Someone else is generally convincing them to go. We definitely see a stigma playing out.”

Part of the problem is that parents often don’t talk to boys about mental-health struggles, and have difficulty with their own understanding of mental illness. A survey by the charity Age U.K. found that 70 percent of adults 55 years or older believe it’s harder for older people to discuss the topic because anxiety and depression weren’t recognized as illnesses when they were growing up. In fact, three-quarters of respondents said they were raised with a “stiff upper lip” attitude, and 22 percent said they feel talking about mental illness would only make it worse.

That silence definitely impacted Nick Muellerleile, 29, who struggled through high school and college before realizing that his lack of happiness and energy wasn’t a phase. Eventually, he booked an appointment with a psychiatrist. The diagnosis — clinical depression — surprised him at first. Then, as he walked through memories from years past, it clicked. He cringes while recalling some of the manic Facebook statuses he posted on his page as a younger man (“I thought I was keeping it together, but people must’ve known”) and surviving for so many years under the sagging weight of consistent unhappiness.

Talking about it, however, didn’t feel like much of an option. Only a chance encounter with some paperwork led him to open up to his parents: His father was sorting through bills when he noticed a medical charge for Muellerleile, who admitted it was from his psychiatrist. “He came across the room, shook his head, and told me, ‘Me too.’ It made things click in place, when I realized there’s a family history, but any time before that would’ve been a better time to tell me,” Muellerleile says. “He hadn’t been open about it at all. Looking back, I realized he had several pill bottles that I never bothered to investigate.”

Shawn, a 29-year-old in Seattle, also struggled to find a support system when he first began navigating big swells of anxiety about three years ago. He had coped with the feeling as a teen, but this was different — a strange and unsettling obsession over his future self, one that didn’t make any sense. He was secure in the fact that he is, by every account, a straight cisgender man. Yet like a shadow in the corner of his eye, Shawn couldn’t shake the sensation that one day he’d wake up, realize he was transgender and lose his hypothetical family and life. At work, at home, at play, the premonition lingered.

After several months of holding it in, Shawn began seeing a mental-health counselor for the first time and received a diagnosis of generalized anxiety disorder. Today, he lives with the understanding that his episodes can be managed. Finding consistent support from his social circle, however, proved more elusive, even though Shawn tried to practice being more open to his male friends in particular. “I’ve been lucky to have some super receptive male friends, but others, I can’t tell if they’re uninterested or if they feel gross talking about it,” he says. “I think the issues revolve around my identity as a man. I’ve never had any doubts about my maleness. But the question of man-ness is…”

He gathers his thoughts.

“I enjoy things and experience emotions that are described in society as feminine, but they’re big parts of my personality,” he continues. “If I suppress those things, does that make me more of a man?”

A major social debate among millennials about gender, including the idea that it isn’t a binary decided solely by our sex birth, is changing the way we define what a man is, and what, if any, traits are “masculine.” But “manhood” remains an elusive goal that men feel pressure to achieve, however they define it, with research suggesting that the inability to capture it leads to aggressive and stress-ridden responses.

Satya Doyle Byock, a Portland, Ore.-based psychotherapist who exclusively treats millennials at her practice Quarter-Life Counseling, has seen a heavy current of disillusionment in her patients, including men who feel lost in their careers and personal lives. Some may seek help after feeling suicidal thoughts or a panic attack, but many more choose to co-exist with a simmering unease they can’t ignore.

“The mid-life crisis, what used to happen in the late 30s or 40s, is happening earlier for young people today,” she explains. “The breakdown often has to do with the question of one’s ‘unlived life,’ and young people are coming to the conclusion that something about society doesn’t work. The problems might be in dating, binge drinking, anxiety or depression, but those things usually have a larger question underneath them.”

One of Byock’s theories is that while older generations often used religious services or intimate community gatherings to reflect on their lives, many of those meditative spaces have been removed from modern life. “Even churches are more like mega-churches now, not for quiet thought,” she says. “It’s created a gaping hole where young people need something to find nourishment.”

They’re not finding it at the office either. Specifically, work-life balance has become harder for a cohort of millennials who matured into the workforce during the dregs of the Great Recession, with shiny college degrees in hand but few employers to court them. More than 50 percent of college students graduated with a job offer in hand in 2007. That number fell to less than 20 percent two years later. And those who did get jobs saw lower starting salaries, with a 2010 study showing that a 1 percent increase in unemployment in a given year meant a 6 to 8 percent drop in starting salary for a college graduate, impacting lifetime savings and benefits. “This cohort of millennials that graduated amid the recession, in the worst of the job market, we’ve got this idea to work so much harder to make up all that was lost,” says Muellerleile.

There’s at least some solace in the fact that millennials are seeing this experience reflected in pop culture. TV shows as diverse as This Is Us, BoJack Horseman, You’re the Worst and even Saturday Night Live have rendered mental-health crises in a stark, heartbreaking and cathartic fashion.

And depression memes are a major currency on social media, with relatable punchlines that poke fun at the hardship. Plus, an increase in resources on campuses and in some workplaces has made it easier to find convenient venues for help. Even the pharmaceutical industry has jumped on an awareness boost, marketing more medications that make it easier to manage moderate and severe disorders.

Yet the question of whether this shift has encouraged more millennial men in particular to seek and stick with professional help remains up in the air. Byock stresses that both men and women are negatively impacted by their interpretation of traditional gender roles, but says, “There’s a lot of work that needs to be done to normalize emotional work for men and women, but definitely more men. We’ve trained society to think women are more emotionally equipped, but we’re also training our boys to lack emotional language. Men and boys have a deep desire to be emotionally intimate, but they don’t have permission. The women in their lives might not think they can go to those intimate places because of how they’ve been trained to think about men.”

The early history of psychotherapy and mental institutions in America created and perpetuated these stigmas. Over the course of the mid- and late-19th century, men committed thousands of women who they deemed “crazy,” with research showing that they were diagnosed as insane for minor faults like “religious excitement,” or inexplicably, “suppressed menstruation.” The power imbalance lasted into the 20th century, and contributed to many men viewing psychotherapy as a sign of weakness.

Cultural differences impact the way people view emotional intimacy and mental health counseling, too, pushing some men even further from the help they need. African-American men, for instance, are 20 percent more likely to report serious psychological distress than white men, but consistently more apprehensive about seeking professional help, according to the nonprofit Mental Health America. Asian Americans also suffer from stigmas about treating mental health issues, despite elevated rates of suicidal ideation — nearly 19 percent of Asian-American high school students report considering suicide, with almost 11 percent actually attempting it, which is significantly more than white students (15.5 percent and 6.2 percent, respectively).

That’s a big factor in why Eugene didn’t want his real name used for this story. “I don’t want my mom to deal with the shame of her son’s mental health being in a fucking feature story,” he says with a short laugh. It also explains why, despite preventative mental health being covered by insurance more than ever in the U.S., men still choose to cope on their own. Case in point: A 2016 study found that women are more likely to accept clinical treatment for mental disorders — and to see greater improvement at the end of their treatment — than male clients. “You feel these kinds of rules that you’re a man, so you need to be able to get through these problems yourself. Especially in America, we value independence and overcoming adversity, even though it really takes a village in reality,” Eugene says.

Today, Eugene admits he’s “pretty shitty” about seeing his therapist on a regular basis, but he’s accepted that when things go south, at least there’s a person he can — and should — call. Otherwise: “You don’t wanna look like something is off, so you keep it to yourself,” he muses. “There’s still a shame and a silence. That’s what somehow needs to change.”